Tuberculosis and how to combat the disease

Tuberculosis or TB is a global pandemic that is being fought by nearly every country in the world. According to the World Health Organization, two billion people — that is one-third of the world’s population — are infected by the TB bacteria worldwide.

TB is an airborne disease that is spread by coughing and sneezing. Women, children and those with HIV-AIDS are said to be the most vulnerable groups for this disease.

This disease is one of the top 10 reasons for death globally and one of the leading causes for infectious diseases. Hence, one of the goals of the United Nations Sustainable Development Goals is to end the epidemic by 2030.

To spread awareness about TB and support efforts to prevent, control and eliminate the disease across the world, March 24 is observed as World Tuberculosis Day. The date coincides with date of discovery of the bacillus Mycobacterium tuberculosis, which causes TB, by German physicist Dr. Rober Koch.

Some statistics on the disease (Source: WHO)

In 2016, 10.4 million people were affected by TB and 1.7 million people died.

More than 95 per cent of TB related deaths happen in low- and middle-income nations.

Around 1 million children fell ill due to TB and 250,000 children died, in 2016.

TB is a major cause of death in HIV-positive people, accounting for 40 per cent of TB-related deaths in 2016.

Growing multi-drug resistance (MDR-TB) is a huge cause of concern in the treatment of the disease. In 2016, there were 600,000 new cases with resistance to rifampicin, the most effective drug to treat TB; of this, 490,000 had MDR-TB.

India leads the countries in the TB burden, followed by Indonesia, China, Philippines, Pakistan, Nigeria and South Africa. These countries account for 64 per cent of the worldwide TB incidence.

WHO statistics for 2016 peg the incidence of TB in India at 2.79 million cases.

How TB manifests itself and spreads

The TB bacteria mainly grows in the lungs (pulmonary TB). But it can also attack any part of the body such as the kidney, spine and brain (extrapulmonary).

There are two kinds of manifestations of the TB bacteria: latent TB infection and active TB disease. In case of latent TB infection, the person is infected with the TB bacteria but does not become sick or exhibit symptoms.

TB bacteria spreads from person to person via the air through sneezing or coughing. It is not spread by shaking hands, sharing food, coming in contact with bed linen or toilet seats, sharing toothbrushes or kissing.

Symptoms of TB

A bad persistent cough that lasts for two weeks or more

Chest pain

Coughing up blood or phlegm from deep inside the lungs

Weakness

Fatigue

Loss of appetite

Weight loss

Chills

Fever

Sweating in the night

Diagnosis

If the above symptoms are noticed, one needs to be tested for TB. If the chest x-ray indicates TB, sputum tests will be done. Sputum is the phlegm that comes out when one coughs. The sputum sample is tested for TB bacteria and drug-resistant strains.

Treatment

Bacille Calmette-Guérin (BCG) is a vaccine given to infants and small children against TB. But this vaccine is not foolproof in protecting people from the disease.

If TB is not treated properly, it can prove to be fatal. Therefore, it is important to treat patients with the correct TB drugs. New TB patients must put through an internationally recognised first-line regimen of TB drugs. The initial phase (8 weeks) involves the drugs Isoniazid, Rifampicin, Pyrazinamide and Ethambutol. This is followed by the drugs Isoniazid, Rifampicin and Ethambutol for 16 weeks.

According to the current daily drug regimen in India, TB patients are given fixed dose combinations in specific dosages (3-4 drugs) in a single pill, every day. These are administered in a scientific manner, based on the patient’s weight.

People suffering from TB must be under direct observation every day. The patients must consume the drugs in front of a DOTS (direct observation short term) agent, who is usually a volunteer or a family member.

Those patients who have been treated earlier for TB and those who have developed drug resistance must be given a retreatment regimen containing first-line drugs, with the addition of streptomycin.

TB may sound like a deadly disease, but there is no need to panic. Timely detection and the right intervention can treat and cure people from TB. Between 2000 and 2016, around 53 million lives were saved worldwide through proper diagnosis and treatment.

Ways to prevent TB and spreading the disease

Ensure the houses is properly ventilated.

Cover your nose and mouth while coughing or sneezing. Use face masks and tissues. Dispose them after use.

Take care when you are in public places with too many people.

Take adequate precautions when you come in contact with people suffering from TB. Healthcare providers must wear respirators.

Children, especially those below the age of five, must be kept away from people with active TB and positive MDR-TB patients.